HEMATOPOIETIC CELL TRANSPLANT AND SKIN CANCER RISK

NEW YORK (Reuters Health) - Hematopoietic cell transplant (HCT) recipients face an increased risk of developing skin cancer, according to results of a systematic review.

"Hematologists, oncologists, primary care physicians, and dermatologists need to be aware of cutaneous malignancy risk factors in patients undergoing hematopoietic cell transplantation," Dr. Jennifer L. DePry, from University Hospitals Case Medical Center, Cleveland, Ohio, told Reuters Health by email.

"These specialties should work as a multidisciplinary team to coordinate patient care to ensure sufficient patient education as well as adequate evaluation and treatment for subsequent malignancies," she said.

Solid-organ transplant recipients have an increased risk of skin cancer that results in part from prolonged immunosuppression. HCT recipients typically have shorter courses of immunosuppression, but still develop secondary skin cancers.

Dr. DePry and colleagues undertook a systematic review of 18 studies to identify the incidence and risk factors for cutaneous malignant neoplasms following HCT.

They found that the 20-year cumulative incidence of cutaneous malignant neoplasms came to 6.5% for basal cell carcinoma (BCC) and to 1.1% for cutaneous squamous cell carcinoma (SCC). Melanomas occurred at rates between 3.5 and 8.3 times those of age- and sex-matched controls.

The median time from HCT to diagnosis of secondary skin cancers ranged from 7.3 to 9.4 years for BCC and 2.1 to 7.0 years for SCC. Half of the melanomas reported occurred between one and four years after the transplant.

Patients with leukemia, lymphoma, and malignant marrow disease seemed to face a higher risk of cutaneous malignancies than patients with other primary cancers, especially for BCC, according to the April 22 JAMA Dermatology online report.

White patients seemed to have a higher risk of BCC, but race did not seem to influence the risk of SCC.

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Acute graft-versus-host disease (GVHD) did not appear to increase the risk of BCC, SCC, or melanoma, but chronic GVHD significantly increased the risk of BCC and SCC.

Treatment of chronic GVHD with immunosuppression (especially with azathioprine) for 24 months or longer further increased the risk of SCC by 8-fold, compared with no treatment for chronic GVHD.

"Further studies need to be undertaken to develop dermatology screening interval guidelines," Dr. DePry said. "Nonetheless, patients should undergo pre-transplant baseline screening and have regular follow-up with dermatology because skin cancer can develop within months of transplantation."

"Additionally," she said, "long-term follow-up is important because the risk of non-melanoma skin cancer continues to increase 15 years after transplantation."

The Char and Chuck Fowler Family Foundation and the Dermatology Foundation supported this research. The authors reported no other disclosures.

SOURCE: http://bit.ly/1KqsUiN

JAMA Dermatol 2015.